Auerbach Jonathan S, Schott Christopher K
Jonathan S. Auerbach is a critical care intensivist at Boca Raton Regional and Bethesda Hospitals and is an affiliate assistant professor of clinical biomedical science in the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.Christopher K. Schott is on staff at VA Pittsburgh Health Care Systems and is an assistant professor of critical care and emergency medicine, director of critical care ultrasonography, and director of the medical student critical care elective at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Crit Care Nurse. 2016 Jun;36(3):e7-e11. doi: 10.4037/ccn2016988.
Solid-organ transplant graft-versus-host disease (SOT-GVHD) is a rare complication of organ transplant that is associated with high mortality. The initial signs and symptoms are vague, so this disease is easily confused with other posttransplant complications. A case of SOT-GVHD occurred after orthotopic liver transplant for liver failure due to hepatitis C in a patient in a Veterans Affairs intensive care unit. The patient had dehydration, acute kidney injuries, rashes, diarrhea, and pancytopenia. Results of skin biopsy, bone marrow biopsy, and cytogenetic studies were consistent with SOT-GVHD. Despite supportive care including antibiotics, antiviral and antifungal therapy, high-dose steroids, antithymoglobulin and neupogen, the patient died of overwhelming sepsis. Owing to the rarity of SOT-GVHD, no evidence-based guidelines or recommendations for treatment exist. Treatment includes high-dose corticosteroids and antibiotic, antifungal, and antiviral prophylaxis. Treatment of liver transplant-related GVHD with anti-tumor necrosis factor a agents has been successful.
实体器官移植移植物抗宿主病（SOT-GVHD）是器官移植中一种罕见的并发症，死亡率很高。其初始症状和体征不明确，因此这种疾病很容易与其他移植后并发症相混淆。一名退伍军人事务部重症监护病房的患者因丙型肝炎导致肝衰竭接受原位肝移植后发生了SOT-GVHD。该患者出现脱水、急性肾损伤、皮疹、腹泻和全血细胞减少。皮肤活检、骨髓活检和细胞遗传学研究结果与SOT-GVHD一致。尽管采取了包括抗生素、抗病毒和抗真菌治疗、大剂量类固醇、抗胸腺细胞球蛋白和重组人粒细胞集落刺激因子在内的支持性治疗措施，该患者仍死于严重脓毒症。由于SOT-GVHD罕见，目前尚无基于证据的治疗指南或建议。治疗包括大剂量皮质类固醇以及抗生素、抗真菌和抗病毒预防。使用抗肿瘤坏死因子α药物治疗肝移植相关的GVHD已取得成功。
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